Statement of Principles concerning alcohol use …

1 Statement of Principles concerning alcohol Use Disorder (Balance of Probabilities) (No. 49 of 2017) Veterans' Entitlements Act 1986 1 of 9 Statement of Principles concerning alcohol USE DISORDER (Balance of Probabilities) (No. 49 of 2017) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986. Dated 18 August 2017 The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of: Professor Nicholas Saunders AO Chairperson Statement of Principles concerning alcohol Use Disorder (Balance of Probabilities) (No. 49 of 2017) Veterans' Entitlements Act 1986 2 of 9 Contents 1 Name.

2 3 2 Commencement .. 3 3 Authority .. 3 4 Revocation .. 3 5 Application .. 3 6 3 7 Kind of injury, disease or death to which this Statement of Principles relates .. 3 8 Basis for determining the factors .. 4 9 Factors that must exist .. 5 10 Relationship to service .. 6 11 Factors referring to an injury or disease covered by another Statement of 6 Schedule 1 - Dictionary .. 7 1 7 Statement of Principles concerning alcohol Use Disorder (Balance of Probabilities) (No. 49 of 2017) Veterans' Entitlements Act 1986 3 of 9 1 Name This is the Statement of Principles concerning alcohol use disorder (Balance of Probabilities) (No. 49 of 2017). 2 Commencement This instrument commences on 18 September 2017.

3 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning alcohol use disorder No. 2 of 2009, as amended, made under subsections 196B(3) and (8) of the VEA is revoked. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies. 6 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about alcohol use disorder and death from alcohol use disorder.

4 Meaning of alcohol use disorder (2) For the purposes of this Statement of Principles , alcohol use disorder means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5): A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least four of the following, occurring within a 12-month period: A. alcohol is often taken in larger amounts or over a longer period than was intended. B. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. C. A great deal of time is spent in activities necessary to obtain alcohol , use alcohol , or recover from its effects.

5 Statement of Principles concerning alcohol Use Disorder (Balance of Probabilities) (No. 49 of 2017) Veterans' Entitlements Act 1986 4 of 9 D. Craving, or a strong desire or urge to use alcohol . E. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home. F. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol . G. Important social, occupational or recreational activities are given up or reduced because of alcohol use. H. Recurrent alcohol use in situations in which it is physically hazardous. I. alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol .

6 J. Tolerance, as defined by either of the following: (i) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or (ii) a markedly diminished effect with continued use of the same amount of alcohol . K. Withdrawal, as manifested by either of the following: (i) the characteristic withdrawal syndrome for alcohol ; or (ii) alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. The definition of alcohol use disorder excludes acute alcohol intoxication in the absence of alcohol use disorder. Note: DSM-5 is defined in the Schedule 1 Dictionary.

7 Death from alcohol use disorder (3) For the purposes of this Statement of Principles , alcohol use disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's alcohol use disorder. Note: terminal event is defined in the Schedule 1 Dictionary. 8 Basis for determining the factors On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that alcohol use disorder and death from alcohol use disorder can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA. Note: relevant service is defined in the Schedule 1 Dictionary.

8 Statement of Principles concerning alcohol Use Disorder (Balance of Probabilities) (No. 49 of 2017) Veterans' Entitlements Act 1986 5 of 9 9 Factors that must exist At least one of the following factors must exist before it can be said that, on the balance of probabilities, alcohol use disorder or death from alcohol use disorder is connected with the circumstances of a person's relevant service: (1) having a clinically significant disorder of mental health as specified at the time of the clinical onset of alcohol use disorder; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (2) experiencing a category 1A stressor within the two years before the clinical onset of alcohol use disorder; Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

9 (3) experiencing a category 1B stressor within the two years before the clinical onset of alcohol use disorder; Note: category 1B stressor is defined in the Schedule 1 - Dictionary. (4) experiencing the death of a significant other within the ten years before the clinical onset of alcohol use disorder; Note: significant other is defined in the Schedule 1 - Dictionary. (5) experiencing severe childhood abuse before the clinical onset of alcohol use disorder; Note: severe childhood abuse is defined in the Schedule 1 - Dictionary. (6) experiencing a category 2 stressor within the six months before the clinical onset of alcohol use disorder; Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

10 (7) having a clinically significant disorder of mental health as specified at the time of the clinical worsening of alcohol use disorder; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (8) experiencing a category 1A stressor within the two years before the clinical worsening of alcohol use disorder; Note: category 1A stressor is defined in the Schedule 1 - Dictionary. (9) experiencing a category 1B stressor within the two years before the clinical worsening of alcohol use disorder; Note: category 1B stressor is defined in the Schedule 1 - Dictionary. (10) experiencing the death of a significant other within the ten years before the clinical worsening of alcohol use disorder; Note: significant other is defined in the Schedule 1 - Dictionary.